Journal of the Indian Society of Pedodontics and Preventive DentistryKavitha Swaminathan, Sunil Babu Kotha, M Sudhindra Baliga, T Subbalekshmi, Selvakumar Haridoss, Apathsakayan Renugalakshmi
Burnout, encompassing high emotional exhaustion (EE), high depersonalisation (DP), and low personal accomplishment (PA) as measured by the Maslach Burnout Inventory (MBI), remains poorly characterised among paediatric dentists. This systematic review and meta-analysis aimed to estimate prevalence of MBI-based burnout dimensions and associated factors, following a protocol prospectively registered with PROSPERO (CRD420251238894) and reported per PRISMA 2020 and MOOSE guidelines. Five databases (PubMed/MEDLINE, Scopus, Web of Science, EBSCOhost, and Cochrane Library) were searched from inception to November 30, 2025, supplemented by Google Scholar, institutional repositories, and author contacts, for quantitative observational surveys using the MBI in paediatric dentists, residents, or faculty. Two reviewers independently extracted study characteristics, MBI domain scores, composite burnout definitions, and associated factors, with discrepancies resolved by consensus; methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies (2020, nine items), and evidence certainty was graded using GRADE. Five cross-sectional surveys (n=915; Jordan, Egypt, Lebanon, United States, and Republic of Korea) met inclusion criteria. Random-effects meta-analysis (Freeman-Tukey transformation) showed pooled prevalence estimates of 45% for high EE (95% CI: 27%-64%), 36% for high DP (10%-67%), and 27% for low PA (10%-49%); two studies using equivalent two-domain criteria yielded a composite burnout prevalence of 16% (4%-34%). Heterogeneity was extreme (I² > 90%) across all outcomes, with very low certainty of evidence. Burnout, particularly EE, is frequently reported among paediatric dentists, though estimates are highly context-dependent, and harmonised, longitudinal, multi-country studies with concurrent mental health measures are needed.
Journal of the Indian Society of Pedodontics and Preventive DentistryNatasha Gambhir, Priyanka Sachdeva, Subhashree Sahoo, Avantika Tuli, Divya Singh, M Sarika
AIM: The study aimed to assess the knowledge and awareness of sensory processing disorder (SPD) and sensory-adapted dental care among pediatric dentists and to identify gaps in the recognition, assessment, and management of children with SPD. MATERIALS AND METHODS: A cross-sectional questionnaire-based survey was conducted among 145 practicing pediatric dentists. A self-administered 14-item questionnaire was developed following a review of the literature to assess knowledge of SPD, awareness of diagnostic approaches, sensory-adapted dental environments (SADEs), and perspectives on caregiver involvement in the dental management of children with SPD. The questionnaire demonstrated acceptable internal consistency (Cronbach's α = 0.622), and principal component analysis identified four components explaining 91.95% of the total variance. Data were analyzed using descriptive statistics and Chi-square tests, with statistical significance set at P < 0.05. RESULTS: Pediatric dentists demonstrated moderate knowledge of the clinical manifestations of SPD. However, awareness of standardized diagnostic tools and SADEs remained limited. Most participants recognized the importance of caregiver involvement and environmental modifications in improving the dental management of children with SPD, highlighting important gaps in diagnostic awareness and sensory-informed clinical care. CONCLUSION: Pediatric dentists demonstrated reasonable knowledge of the clinical manifestations of SPD; however, important gaps remain in awareness of diagnostic assessment methods and sensory-adapted dental care strategies. These findings highlight the need to strengthen undergraduate and postgraduate training and continuing dental education to promote evidence-based, sensory-informed pediatric dental care.
Journal of the Indian Society of Pedodontics and Preventive DentistryBalaji Suresh, Nandini Devi Madiajagane, Maria Anthonet Sruthi
PURPOSE: To compare the diagnostic accuracy and public health utility of Gemini 2.5 Flash and GPT-4 for early childhood caries (ECC) risk triage in classifying presentations as high risk (warranting immediate referral) or low risk (amenable to preventive counseling). MATERIALS AND METHODS: A standardized dataset of 50 clinical vignettes (25 high risk and 25 low risk) was evaluated against both large language models via official application programming interfaces using a blinded, prospective comparative design (CONSORT-AI; TRIPOD+AI). This constitutes a vignette-based internal validation study and does not represent a clinical diagnostic accuracy study. Ground truth was established by two consultant pediatric dentists (intraclass correlation coefficient = 0.92). Performance was quantified using sensitivity, specificity, positive predictive value, negative predictive value, and false negative rate (FNR). Readability, actionability, and multilingual competence in Hindi and Tamil were additionally assessed. RESULTS: Both models exceeded the 80% accuracy threshold. GPT-4 achieved significantly higher sensitivity (92.0% vs. 80.0%; P = 0.032) and a lower FNR (8.0% vs. 20.0%), with superior readability (Flesch-Kincaid Grade Level 5.9 vs. 8.1), actionability (4.8 vs. 4.2), and cross-lingual consistency. Both models achieved 100% safety disclaimer compliance in English. CONCLUSIONS: GPT-4 demonstrates a statistically superior safety profile for ECC risk triage. As a Level 1 adjunct, it can assist pediatric dentists by prescreening caregiver-reported presentations, reducing diagnosis lag, and directing specialist capacity toward confirmed high-risk pathology without replacing clinical judgment. CLINICAL RELEVANCE: This study establishes that GPT-4 is a safer and more accessible AI triage tool than Gemini 2.5 Flash for pediatric dental screening, particularly in linguistically diverse, resource-constrained settings where specialist access is limited.
OBJECTIVES: Managing injection pain is critical for pediatric patient cooperation. The clinical benefit of using 7.5% sodium bicarbonate-buffered lidocaine, compared to its unbuffered counterpart, has not been extensively studied in children using a controlled split-mouth design. Hence, this clinical trial aimed to compare the pain control efficacy of buffered versus conventional lidocaine in pediatric dentistry, assessing pain during injection, anesthetic depth, and anesthetic onset. MATERIAL AND METHODS: A randomized, split-mouth, crossover, double-blind clinical trial was conducted involving 53 healthy children referred to the Kerman Dental School. Children requiring local anesthesia for the same dental procedure on two molars of the same name in one jaw were randomly assigned to Group 1 (first session: conventional 2% lidocaine; second session: buffered 2% lidocaine with 7.5% sodium bicarbonate) and Group 2 (reverse sequence). The two sessions were separated by a 1‑week washout period. Pain during injection was assessed using the SEM (Sound, Eye, Motor) scale and the FPS-R (Facial Pain Scale-Revised), and pulse rate changes were monitored. The SEM scale also assessed both the anesthetic onset and depth. RESULTS: Buffered lidocaine resulted in significantly lower SEM scores during injection (a 17% reduction; Exp(β) = 1.17, 95% CI [1.10, 1.23], p < 0.001) and faster anesthetic onset (a 6% improvement; Exp(β) = 1.06, 95% CI [1.01, 1.11], p = 0.011) compared with conventional lidocaine. These improvements did not extend to subjective pain scores (FPS‑R), where no significant difference was observed. Pulse rate increased similarly after the injection of either local anesthetic formulation, with no treatment‑dependent hemodynamic effect. CONCLUSIONS: The administration of buffered lidocaine with 7.5% sodium bicarbonate significantly improved objective behavioral outcomes, as evidenced by lower SEM scores and a quicker onset, compared to conventional lidocaine. While these findings did not extend to subjective pain scores, the reduction in physical distress behaviors advocates for its clinical use in pediatric dental procedures. TRIAL REGISTRATION: IRCT20241119063775N1.
Pediatric dentistryAlyssa Moy, Travis Nelson, Stephen Wilson, Thomas Tanbonliong
Purpose: To compare moderate enteral sedation regulations across the 50 US states and evaluate alignment with the American Academy of Pediatrics/American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA) guidelines. Methods: An online review of all state dental sedation laws was conducted from January to June 2025. Extracted variables include permit type, renewal interval, site visit, and education requirements. State regulations were compared with the AAPD Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures and the ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students.Results: Forty-eight states (96%) require a permit to administer moderate enteral sedation. The most common renewal interval is 2 years (58%), and two-thirds of states require 1 to 5 annual continuing education hours. Twenty states (40%) require a pediatric endorsement. Nearly all states (98%) mandate advanced life-support training for pediatric patients. More than half (64%) require an initial site visit, and 50% require regular emergency drills. Educational standards vary, though 60 didactic hours and 20 cases are most common. Most states (86%) require Basic Life Support (BLS) for monitoring personnel, and 56% require at least 2 individuals during procedures. Conclusions: Despite increased alignment with published sedation guidelines in recent decades, significant variability persists among state permit definitions and requirements. These findings highlight the need for standardized, evidence-based state dental practice acts that clearly define sedation depths, routes, and training requirements.
Pediatric dentistryAndrea Akabike, Courtney M Hill, Gulaiim Almatkyzy, Paul Casamassimo, Chelsea Fosse, Travis Nelson, Peggy P Lee, Donald L Chi
Purpose: To investigate pediatric dental providers' experiences with parent radiographic imaging refusal and identify practice and parent characteristics associated with refusal. Methods: American Academy of Pediatric Dentistry (AAPD) members were invited via email in October and November 2024 to participate in an online questionnaire about radiograph imaging refusal (intraoral, extraoral, and cone beam computed tomography [CBCT]). Chi-square tests identified factors associated with refusal. Results: A total of 695 of 8,295 dental providers responded to the survey (8.4%). Most were women (60.7%) and White (71.8%). Between 9% and 23% reported parent radiographic imaging refusal as a big or medium-sized problem (intraoral=23%; extraoral=12%; CBCT=9%). Intraoral and extraoral refusal was more commonly reported by private practice providers (versus community health centers or university/hospitals) and providers treating fewer than 50% Medicaid-insured patients (versus more than 50% Medicaid-insured patients; P<0.05). Providers reported that parents who refused bitewing radiographs also tended to refuse fluoride and immunizations. Most providers (87.6%) continued to use lead shielding because of the belief that it improves acceptance of radiographs (71.9%). Conclusions: Parent intraoral radiography refusal is a commonly reported challenge in dentistry and highlights the importance of developing chairside strategies aimed at supporting parent decision-making and timely dental disease diagnosis and treatment.
Journal of the Indian Society of Pedodontics and Preventive DentistryYash Bafna, Shahid Shaikh, Shobha Fernandes
BACKGROUND: Molar-incisor hypomineralization (MIH) is associated with hypersensitivity and resistance to local anesthesia (LA), which complicates treatment in children. No nationwide study has examined the frequency of these anesthetic challenges among pediatric dentists or their association with clinician stress and burnout. The aim of the study was to assess the prevalence of LA inadequacy in MIH-affected teeth and its relationship with stress, burnout, and job satisfaction among pediatric dentists. MATERIALS AND METHODS: A cross-sectional online survey was conducted among qualified pediatric dentists across India using a validated questionnaire. Convenience and snowball sampling yielded 100 complete responses after exclusion. The instrument covered sociodemographics, MIH clinical experience, anesthetic difficulties, escalation practices, and well-being (modified Mini Copenhagen Burnout Inventory). Data were analyzed using descriptive statistics, nonparametric tests, Chi-squared tests, Spearman correlations, and multivariable linear regression adjusted for confounders. RESULTS: Most respondents reported routine LA inadequacy in MIH cases, commonly with supplemental buccal infiltration and intraligamentary injections. Higher perceived LA failure was strongly associated with treatment postponement, extraction, and general anesthesia referral. MIH-related anesthetic stress was strongly correlated with higher burnout and lower job satisfaction. Multivariate analysis identified elevated MIH workload, corporate/private college settings, and longer experience as independent predictors of poorer well-being. CONCLUSION: LA challenges in MIH management are prevalent among Indian pediatric dentists and significantly contribute to occupational stress and burnout. Targeted training in adjunctive techniques and institutional wellness support are recommended to improve clinician resilience and patient care.
Annals of plastic surgerySerena N Kassam, Daniela Garib, Maria Costanza Meazzini
Challenges in orthodontic management for patients with cleft lip and palate (CLP) center on facial growth deficiencies and oral health. Patients with complete CLP exhibit maxillary arch constriction from an early age, typically more severe in the canine region than in the molar region. Transverse management centers on the maxillary arch and types of expansion. The ability to provide targeted anterior expansion while simultaneously addressing posterior crossbites is crucial for correcting arch constriction in patients with cleft lip and palate. Maxillary constrictions are usually addressed immediately prior to the secondary alveolar bone graft procedure. The instability of maxillary expansion in CLP patients is one reason why expansion is often performed early. Anteroposterior (sagittal) orthopedic management of maxillary deficiencies in patients with CLP still remains a challenge, with decisions on treatment based on timing, indications, and severity. A protocol is presented with favorable results for complicated cases. Early correction of the hypoplastic maxilla in patients with CLP is notoriously followed by substantial skeletal relapse; consequently, protraction undertaken in the deciduous or early-mixed dentition should be reserved for cases in which marked functional impairment, such as hipoacusia, is present. Conversely, when the same orthopedic stimulus is applied in proximity to the pubertal growth spurt, the skeletal correction tends to be considerably more stable. Challenges in pediatric dentistry persist with poor oral hygiene and caries. Without a foundation for stable dentition, the best of orthodontic treatment planning can be compromised. Despite awareness on importance of oral health as it relates to systemic conditions and the additional factors faced with CLP patients, more follow-up is needed. Prevention and frequent follow-up with the pediatric dentist are key.
General dentistryCarolyn Griffin, Qingzhao Yu, Nubaira Rizvi, Richard W Ballard, Paul C Armbruster
This study evaluated and compared the perceptions of general dentists, pediatric dentists, and orthodontists regarding the need for transverse maxillary expansion for Class I malocclusions with posterior crossbite. An electronic survey consisting of digitally manipulated intraoral images depicting 8 clinical scenarios was distributed to 10,000 general dentists, 8734 pediatric dentists, and 2400 orthodontists. A total of 566 practitioners responded (2.7% response rate): 85 general dentists, 339 pediatric dentists, and 142 orthodontists. For each case, participants assessed the need for expansion, type of expansion, and referral preferences. Statistical analyses included chi-square tests and multivariable logistic regression, which were adjusted for specialty, years of experience, and geographic region. Significant differences in perception were observed in 6 of the 8 cases (P < 0.05), primarily influenced by specialty training. Orthodontists demonstrated significantly higher odds of recommending expansion than general dentists, particularly in more complex presentations. Pediatric dentists more frequently opted for referral rather than treatment. Neither years of practice nor geographic region significantly influenced diagnostic decisions. Survey reliability demonstrated moderate to substantial agreement across repeated cases (κ = 0.424 to 0.677), and power analysis indicated sufficient sample size and effect sizes for most scenarios. These findings suggest that specialty training strongly influences the perceived need for transverse maxillary expansion, highlighting a potential need for enhanced orthodontic diagnostic education in dental and pediatric residency programs to promote consistency in the diagnosis and management of transverse discrepancies across dental specialties.
Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric DentistryMelda Karavuş, Hatice Büşra Arısın, Ezgi Didem Bakırkaynak, Zeynep Akkuzugil, Selin Ece Tahan, Mehmet Emre Kekeç, Emre Akkuş, Şevket Girgin, Nimet Emel Lüleci,…
AIMS: This study aimed to qualitatively evaluate the awareness, knowledge levels, and clinical approaches of dental residents regarding the dental management and characteristics of individuals with Autism Spectrum Disorder (ASD). METHODS AND RESULTS: Using a phenomenological qualitative design, data were collected through semi-structured, in-depth interviews with dental residents at a public university in Istanbul, Türkiye. Transcripts were analyzed via ATLAS-ti software to identify themes and sub-themes. Residents recognized key ASD traits such as repetitive behaviors, sensory sensitivities, and communication barriers. The theme "Experience During Examination" highlighted significant challenges, including patients' difficulty following instructions and fear of the clinical setting. Results indicated that residents utilize behavioral management strategies, such as providing isolated, low-stimulus environments and using visual aids or relaxing music. While some managed difficulties through adapted interactions, others reported a need to refer patients for conscious sedation or general anesthesia for invasive procedures. CONCLUSION: Although dental residents demonstrate a foundational awareness of ASD, they face practical challenges in clinical examination and treatment. Enhancing specialized training in behavioral management and providing low-stimulus clinical settings are essential to improve oralhealthcare outcomes for patients with ASD.